Most smokers begin smoking during their teens.1 A person who smokes cigarettes in adolescence is more likely to progress to daily smoking and become addicted than someone who experiments with cigarettes in adulthood.2 About three-quarters of teenagers who smoke regularly continue to smoke as adults. Those who start smoking as teenagers smoke for longer and more heavily, on average, than those who start smoking at a later age.3 These smoking patterns increase the risk of developing tobacco-related disease later in life.1

Signs of tobacco addiction may occur more rapidly in adolescent smokers at lower or more intermittent levels of consumption.4–6 US research using the Hooked on Nicotine Checklist ('HONC'—see Section 6.5) has shown that adolescents lose autonomy over their smoking on average within two months of the onset of smoking. The median amount of smoking at which symptoms of dependency were reported was two cigarettes per day, smoked on one day per week. Those adolescent smokers who smoked only occasionally were less likely to develop any HONC symptoms and were more easily able to quit smoking. The frequency of smoking increased after one or more symptoms of dependency were reported. Although smokers may have recognised the emergence of dependence symptoms and attempted to quit, they found quitting more difficult than those who did not smoke regularly.7

In US research using the HONC, 40% of young smokers aged 12–13 (followed up over 30 months) reported symptoms of dependence.8 In those who reported inhaling tobacco smoke, 58% reported symptoms of dependence. In those who reported one or more symptoms of dependence, 18% did so soon after their first use, 33% did so when smoking once monthly, 49% when smoking weekly, and 70% did so before they started smoking daily.8 Girls were more likely to report symptoms of dependence than boys, and experienced them sooner after starting smoking (21 days for girls compared to 183 days for boys).8 Adolescents who experienced nausea, dizziness or relaxation when they initially smoked a cigarette were much more likely to develop a HONC symptom than those who did not.7 Other US research shows that younger smokers (aged 10–18) are twice as likely to report that 'it's really hard to quit' than older smokers (aged 19–22) who smoke the same amount.9

One hypothesis to explain the younger smokers' increased susceptibility to tobacco addiction is the greater immaturity of the adolescent brain, which allows nicotine to have more disruptive effects on brain function.3, 10, 11 There is a significant gap between the reality of adolescent addiction to nicotine and young smokers' beliefs about their ability to control their use of the substance. This is discussed in Section 6.11.

References

1. US Department of Health and Human Services. Preventing tobacco use among young people: a report of the Surgeon General. Atlanta, Georgia: US Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1994. Available from: http://www.cdc.gov/tobacco/data_statistics/sgr/1994/index.htm/